Method for nasal application of a medicinal substance

ABSTRACT

A method for nasal application of a medicinal substance by applying the substance through the nose in a maximum amount that is insufficient to stimulate an excretory response that would clear a significant portion of the substance from nasal and sinus passages. Within a time period of less than one hour, the application of the substance through the nose in an amount that is insufficient to stimulate an excretory response that would clear a significant portion of the substance from nasal and sinus passages is repeated. The repeated application, at a minimum, is done a sufficient number of times to provide an effective total dose of the substance. The repeated application, in any case, is done at least once.

[0001] This is a Continuation-in-Part of co-pending U.S. application Ser. No. 09/877,605, filed Jun. 8, 2001.

BACKGROUND OF THE INVENTION

[0002] This invention relates to delivery of a medical substance to a mammal and more particularly relates to nasal delivery of such a substance for absorption, reaction or other utilization.

[0003] Nasal administration of medical substances has had significant disadvantages. Dosages have been difficult to control due to excretory responses to administration, e.g. sneezing and mucosal excretion that removes or significantly reduces the substance from the nasal passages and sinuses. Another problem is that administered substances removed by an excretory response are often swallowed leading to nausea, stomach upset or other digestive disturbance. An even more serious problem is that if the excretory response is strong enough, the substance can be inhaled causing coughing or more serious pulmonary distress. An even further problem is that when a significant amount of the medical substance is removed by an excretory response, the material excreted is wasted material, thus increasing costs and inefficiencies associated with nasal administration.

BRIEF DESCRIPTION OF THE INVENTION

[0004] In accordance with the invention a method is therefore provided for nasal application of a medicinal substance which overcomes the above disadvantages. In particular, the method comprises applying the substance through the nose in a maximum amount that is insufficient to stimulate an excretory response that would clear a significant portion of the substance from nasal and sinus passages and within a time period of less than one hour, and repeating the application of the substance, through the nose in an amount that is insufficient to stimulate an excretory response that would clear a significant portion of the substance from nasal and sinus passages. The repeated application, at a minimum, is done a sufficient number of times to provide an effective total dose of the substance. The repeated application, in any case, is done at least once.

DETAILED DESCRIPTION OF THE INVENTION

[0005] “Nasal application”, as used herein, means applied through the nose into the nasal or sinus passages or both. The application may, for example, be done by drops, sprays, mists, coatings or mixtures thereof applied to the nasal and sinus passages.

[0006] “Medicinal substance” means any substance capable of being effectively applied nasally. Such substance are usually in the form of liquids, but may also be vapors or fine solids. Such substances are either absorbed by the tissues and vessels in the nasal and sinus passages (nasally absorbable) or interact with the surface of such passages (nasally active). Such substances may for example include vaccines, antigens, epitopes, adjuvants, viral vectors, bacterial vectors, immune modulators, delivery vehicles, and other drugs such as antibiotics, antivirals, hormones, antibodies, anti-inflammatories, antipyretics, antispasmotics, sedatives, anesthetics, chemotherapeutic agents, analgesics, vasodialators, and vasoconstrictors.

[0007] When the medical substance is a vaccine it may for example be a vaccine for non-typeable haemophilus influenzae which may contain an epitope of P5, P6 or both P5 and P6 proteins of haemophilus influenzae. The vaccine may also for example be a vaccine against hepatitis B.

[0008] The maximum amount that is insufficient to stimulate an excretory response that would clear a significant portion of the medicinal substance from the nasal and sinus passages is readily determined by observation and varies with the substance being applied, the surface area of the nasal passages and sinuses and with the size and species of animal. In the case of a mouse, the maximum amount is usually between about 2 and 10 μl and for a human is usually from about one to about three drops.

[0009] “Excretory response” means a response by the animal that tends to clear a significant portion of the medicinal substance from the nasal passages and sinuses. Such responses include increased secretions from the surfaces of the nasal passages and sinuses, and sneezing. Increased secretions may dilute the substance and can be removed from the nasal passages and sinuses by sneezing, blowing, dripping, coughing and swallowing.

[0010] “Significant portion” means that the effectiveness of the substance is substantially reduced (e.g. a reduction in effectiveness greater than 20 percent) due to excretion. A “significant portion” would normally be between 10 and 30 percent of the applied dose.

[0011] Repeated applications to obtain a maximum dose without stimulating an excretory response, for practical reasons related to the value of doctor and patient time, are usually completed within an hour and preferably less, e.g. one-half hour. The total number of doses within an hour is at least two but to obtain maximum effective dose, usually the number of doses is between 3 and about 20 and preferably between 4 and about 12 within an hour. Commonly, the number of applications is from 3 to about 15 applications within an hour. The time interval between doses is usually between about 30 seconds and about 15 minutes.

[0012] The method of the invention is applicable to essentially any mammal having easily accessible nasal passages and sinuses, e.g. mice, rats, chinchillas and other rodents, cats, monkeys, apes and humans. It has been found that position of certain mammals may increase effectiveness. For example, application is more effective in a prone chinchilla than a supine chinchilla and more effective in a supine mouse than a prone mouse. Nevertheless, the method of the invention using repeated doses, below the amount that stimulates a significant excretory response, is more effective than single doses when other variables are constant.

[0013] The following examples serve to illustrate but not limit the invention.

[0014] To show the distribution of liquid administered through the nose, Evans Blue Dye (0.3%) was administered through a micropipette tip into the nose of mice and chinchillas at various doses, at various levels of sedation or anesthesia, and with the animals in various positions.

[0015] The results clearly show that when a lower dose is used, more dye is retained in the nasal passages and sinuses and less dye is lost to the esophagus, stomach, intestines and lungs. The results further clearly show that when a series of low doses are used near the point at which the animal excretes the dye to the esophagus, stomach and intestines, more material can be retained in the nasal passages and sinus cavities than when a single larger dose is used. Further interesting results are that more dye is retained in the nasal passages and sinuses in the chinchilla, when the dye is administered in the prone position than when administered in the supine position but the converse is true for mice. Further, more dye is retained in the nasal passages and sinuses when administered to an alert chinchilla but again the converse is true for the mouse where an anesthetized state is preferred. In most cases, a divided dose permits more material to be retained in the nasal area.

[0016] The following table shows results for tests conducted with mice. Except as noted above, similar results occurred with tests conducted using chinchillas.

[0017] In the following tables “-” means that no dye is present, “traces” means that minimal amounts are present when examined with the unaided eye but that do not clearly show on photographs, “yes” and “+” mean dye is clearly visible, and “++” means heavy dye presence.

[0018] Table 1 shows the results for a control mouse treated with 10 μl of phosphate buffer solution (PBS) and no dye.

[0019] Table 2 shows the results for dye administered in various concentrations in a single dose with heavy anesthesia.

[0020] Table 3 shows the results for dye administered in various concentrations in a single dose with moderate anesthesia.

[0021] Table 4 shows the results for dye administered in a supine position at various concentrations in a single dose with heavy anesthesia.

[0022] Table 5 shows the results for dye administered in various concentrations in a single dose to alert animals.

[0023] Table 6 shows the results for dye administered at 30 μl concentration in a single dose to alert animals.

[0024] Table 7 shows the results for dye administered dropwise at 30 μl and 50 μl concentrations under heavy and moderate anesthesia.

[0025] Table 8 shows the results for dye administered in 5 μl and 2 μl increments showing reduced dye in the stomach at lower incremental doses than larger incremental doses and less the same summed quantity supplied in a single dose. Table 3 shows the results for dye administered in various concentrations in a single dose with moderate anesthesia.

[0026] Table 9 shows optimal divided dose conditions for the mouse where essentially no dye reached the stomach and very little dye reached the esophagus. TABLE 1 Control Position Position Time At Post To Esophagus Trachea Mouse Dye Deliv- Deliv- Sacri- Nose Nasal Oral Upper/ Intes- Upper/ # Volume ery ery Anesthesia fice Skin Cavity Cavity Larynx Lower Stomach tine Lower Lung Notes 1 0 μl N/A N/A N/A N/A − − − − −/− − − −/− − Control (10 μl mouse; of 10 μl PBS) of PBS total.

[0027] TABLE 2 Dye Test, 200 μl of anesthesia (heavy) Position Position Mouse Dye At After Anesthesia Time To Nose Nasal Oral # Volume Delivery Delivery Dose/Level Sacrifice Skin Cavity Cavity 2 10 μl Upright Not held 200 μl 60 min Yes Yes Yes (heavy) 3 10 μL Upright Not held 200 μl 60 min Yes Yes Yes (heavy) 4 20 μl Upright Not held 200 μl 60 min Yes Yes Yes (heavy) 5 20 μl Upright Not held 200 μl 60 min Yes Yes Yes (heavy) 6 30 μl Upright Not held 200 μl 60 min Yes Yes Yes (heavy) 7 30 μl Upright Not held 200 μl 60 min Yes Yes Yes (heavy) 8 40 μl Upright Not held 200 μl 60 min Yes Yes Yes (heavy) 9 50 μl Upright Not held 200 μl 60 min Yes Yes Yes (heavy) 10  50 μl Upright Not held 200 μl 60 min Yes Yes Yes (heavy) Esophagus Trachea Mouse Upper/ Upper/ # Larynx Lower Stomach Intestine Lower Lung Notes 2 Yes Traces/ Traces − −/− − Dye did not travel Traces far 3 Yes Yes/Yes + − Traces/ − Traces of dye were Traces seen in the bronchial bronchial tubes and also appeared in the stomach 4 Yes Yes/Yes + − −/− − Dye appeared in stomach 5 Yes Yes/Yes + − −/− − Dye appeared in stomach 6 Yes Yes/Yes + − Yes/Yes + Dye was present in the Left stomach and left lung Lung only 7 Yes Yes/Yes − − Yes/Yes + Dye was throughout esophagus and stopped just before entering the stomach. Dye was mostly in the lungs 8 Yes Yes/Yes + Yes Yes/Yes + There was a slight Right presence of dye in the lung right lung and none in the left lung 9 Yes Yes/Yes + − Yes/Yes + Dye was prominent in all examined areas except intestine 10  Yes Yes/Yes + − Yes/Yes ++ See above

[0028] TABLE 3 Dye Test, 120 μl of anesthesia (moderate) Position Position Mouse Dye At Post Anesthesia Time To Nose Nasal Oral # Volume Delivery Delivery Dose/Level Sacrifice Skin Cavity Cavity 11 30 μl Upright Not held 120 μl 60 min Yes Yes Yes (Mod) 12 30 μl Upright Not held 120 μl 60 min Yes Yes Yes (Mod) 13 50 μl Upright Not held 120 μl 60 min Yes Yes Yes (Mod) 14 50 μl Upright Not held 120 μl 60 min Yes Yes Yes (Mod) Esophagus Trachea Mouse Upper/ Upper/ # Larynx Lower Stomach Intestine Lower Lung Notes 11 Yes Yes/Yes ++ − Yes/Yes Traces Traces of dye in the lungs, and heavy in the stomach 12 Yes Yes/Yes + − Yes/Yes Traces Less presence of the dye in the stomach than #11 13 Yes Yes/Yes ++ − Yes/Yes Traces Traces of dye in the lungs and heavy in the stomach 14 Yes Yes/Yes ++ Yes Yes/ − Traces seen in Traces esophagus and trachea. Heavy in the stomach

[0029] TABLE 4 Dye Test; Supine/Supine Position Position Time At Post Anesthesia To Nasal Oral Esophagus Trachea Mouse Dye Deliv- Deliv- Dose/ Sacri- Nose Cav- Cav- Upper/ Intes- Upper/ # Volume ery ery Level fice Skin ity ity Larynx Lower Stomach tine Lower Lung Notes 15 10 μl Supine Supine 200 μl 60 Yes Yes − Yes −/− − − −/− − (heavy) min 16 20 μl Supine Supine 200 μl 60 Yes Yes Yes Yes Traces/− − − Traces/ − Dark spot in (heavy) min Traces lungs was blood 17 30 μl Supine Supine 200 μl 60 Yes Yes Yes Yes Yes/Yes + − Yes/Yes − Oral delivery (heavy) min 18 30 μl Supine Supine 200 μl 60 Yes Yes Yes Yes Yes/Yes − − Yes/Yes − Dye was (heavy) min present in the esophagus

[0030] TABLE 5 Varying Dye Volume; Alert Animals Position Position Mouse Dye At Post Anesthesia Time To Nose Nasal Oral # Volume Delivery Delivery Dose/Level Sacrifice Skin Cavity Cavity 19 10 μl Upright Not held 0 μl (Alert) 60 min − Yes Yes 20 10 μl Upright Not held 0 μl (Alert) 60 min − Yes Yes 21 30 μl Upright Not held 0 μl (Alert) 60 min Yes Yes Yes 22 30 μl Upright Not held 0 μl (Alert) 60 min Yes Yes Yes 23 50 μl Upright Not held 0 μl (Alert) 60 min Yes Yes Yes 24 50 μl Upright Not held 0 μl (Alert) 60 min Yes Yes Yes Esophagus Trachea Mouse Upper/ Upper/ # Larynx Lower Stomach Intestine Lower Lung Notes 19 Yes −/− + Yes −.− − Relative to other mice this mouse did not struggle much during delivery into first nare but slightly struggled during delivery into second nare. 20 Yes −/− Traces Yes −/− − See above. 21 Yes −/− ++ Yes −/− − There was a great deal of gurgling and coughing of dye. A lot of dye appeared immediately in the mouth upon delivery. 22 Yes −/− + Yes −/− − See above. 23 Yes Traces/ ++ Yes −/− − Mouse sneezed and Traces spit up dye into mouth from nasal cavity. It was very difficult to administer all 50 μl. 24 Yes −/− + Yes −/− Traces See above. Dye was present in traces in bronchii.

[0031] TABLE 6 Varying Position During Administration; Alert Animals Position Position Time At Post Anesthesia To Nasal Oral Esophagus Trachea Mouse Dye Deliv- Deliv- Dose/ Sacri- Nose Cav- Cav- Upper/ Stom- Intes- Upper/ # Volume ery ery Level fice Skin ity ity Larynx Lower ach tine Lower Lung Notes 25 30 μl Prone Not 0 μl 60 − Yes Traces Traces −/− + Yes −/− Yes Dye almost held (Alert) min completely moved into the intestine. 26 30 μl Prone Not 0 μl 60 − Yes Traces Traces −/− ++ Yes −/− − Dye moved held (Alert) min through the esophagus completely and was in the stomach.

[0032] TABLE 7 Drop-Wise Administration of Dye Position Position Mouse Dye At Post Anesthesia Time To Nose Nasal Oral # Volume Delivery Delivery Dose/Level Sacrifice Skin Cavity Cavity 27 30 μl Upright Not held 200 μl 60 min Yes Yes Yes 1 drop/ (heavy) 5 sec interval 28 50 μl; Upright Not held 120 μl 60 min Yes Yes Yes 5 μl/ (Mod) nare at 30 sec interval Esophagus Trachea Mouse Upper/ Upper/ # Larynx Lower Stomach Intestine Lower Lung Notes 27 Yes Yes/Yes + − −/− − Drops were released and inhaled slowly pausing for five seconds in between. All dye moved down esophagus and into stomach. 28 Yes Yes/Yes + − −/− − Drops were released and inhaled, slowly paused for 30 seconds in between. All dye moved down esophagus into stomach. Animal was not fully asleep.

[0033] TABLE 8 20-40 μl of Dye, Divided Doses (different intervals), 200 μl of anesthesia (heavy*), Supine/Supine Position Position Mouse Dye At Post Anesthesia Time To Nose Nasal Oral # Volume Delivery Delivery Dose/Level Sacrifice Skin Cavity Cavity 29 30 μl; Supine Supine 200 μl 60 min Yes Yes − 5 μl/ (heavy) nare at 10 min interval 30 30 μl; Supine Supine 200 μl 60 min Yes Yes Yes 5 μl/ (heavy) nare at 10 min interval 31 20 μl; Supine Supine 200 μl 60 min Yes Yes − 2 μl/ (heavy) nare at t = 0, 2, 7, 9 and 11 min 32 20 μl; Supine Supine 200 μl 60 min Yes Yes Yes 2 μl/ (heavy) nare at 2 min interval 33 20 μl; Supine Supine 200 μl 60 min Yes Yes Yes 2 μl/ (heavy) nare at 5 min interval 34 40 μl; Supine Supine 200 μl 60 min Yes Yes Yes 2 μl/ (heavy) nare at 5 min interval 35 30 μl; Supine Supine 200 μl 60 min Yes Yes Yes 2 μl/ (Mod*) nare at 5 min interval 36 30 μl; Supine Supine 200 μl 60 min Yes Yes Yes 2 μl/ (Mod*) nare at 5 min interval Esophagus Trachea Mouse Upper/ Upper/ # Larynx Lower Stomach Intestine Lower Lung Notes 29 Yes Yes/Yes + − Yes/Yes + 30 Yes Yes/Yes + − Yes/Yes Traces 31 Yes −/− − − −/− − The 5 min interval between t = 2 and t = 7 min favored in maintenance 32 Yes Yes/Yes + − −/− − 33 Yes Yes/− − − −/− − 34 Yes Yes/Yes ++ − −/− − Mouse started to wake after about 32 μl were administered. 35 Yes Yes/Yes + − −/− − Mouse was NOT heavily anesthetized at like others given the same amount of anesthesia. It began to wake and move after being given 16 μl of dye. 36 Yes Yes/Yes + − −/− − See above

[0034] TABLE 9 Optimal Conditions for Intranasal Delivery and Maintenance Position Position Mouse Dye At Post Anesthesia Time To Nose Nasal Oral # Volume Delivery Delivery Dose/Level Sacrifice Skin Cavity Cavity 37 30 μl; Supine Supine 200 μl 60 min Yes Yes Yes 2 μl/ (heavy) nare at 5 min interval 38 30 μl; Supine Supine 400 μl 60 min Yes Yes Yes 2 μl/ (heavy) nare at 5 min interval 39 30 μl; Supine Supine 350 μl 60 min Yes Yes Yes 2 μl/ (heavy) nare at 5 min interval Esophagus Trachea Mouse Upper/ Upper/ # Larynx Lower Stomach Intestine Lower Lung Notes 37 Yes Traces/− − − −/− − A small isolated patch was found halfway down esophagus. No dye was in stomach, trachea or lungs. The dark spots on the lungs are blood clots. 38 Yes −/− − − −/− − Animal needed additional anesthetic during dye adminis- tration in order to stay heavily anesthetized until dye was completely administered. 39 Yes Traces/− − − Traces/− − Animal needed additional anesthetic during dye adminis- tration in order to stay heavily anesthetized until dye was completely administered. 

What is claimed is:
 1. A method for nasal application of a medicinal substance which comprises applying the substance through the nose in a maximum amount that is insufficient to immediately stimulate an excretory response that would clear a significant portion of the substance from nasal and sinus passages and within a time period of less than one hour, and repeating the application of the substance, through the nose in a maximum amount that is insufficient to immediately stimulate an excretory response that would clear a significant portion of the substance from nasal and sinus passages, at least once and at a minimum a sufficient number of times to provide an effective total dose of the substance.
 2. The method of claim 1 where the application is repeated a sufficient number of times within the hour to maximize the total dose without stimulating an excretory response that would clear a significant portion of the substance from nasal and sinus passages.
 3. The method of claim 1 where the substance is a nasally absorbable medicine.
 4. The method of claim 1 where the substance is a nasally active medicine.
 5. The method of claim 1 where the substance is selected from the group consisting of vaccines, antigens, epitopes, adjuvants, viral vectors, bacterial vectors, immune modulators, delivery vehicles, and drugs including antibiotics, hormones, antibodies, anti-inflammatories, antipyretics, antispasmotics, anesthetics, chemotherapeutic agents, sedatives, analgesics, vasodialators, and vasoconstrictors.
 6. The method of claim 1 where the number of applications is from 3 to about 15 applications within the hour.
 7. The method of claim 1 where the mammal is a supine mouse.
 8. The method of claim 1 where the mammal is a prone chinchilla.
 9. The method of claim 1 where the mammal is a human.
 10. The method of claim 1 where the medical substance is a vaccine.
 11. The method of claim 10 where the vaccine is a vaccine for non-typeable haemophilus influenzae.
 12. The method of claim 11 where the vaccine contains an epitope of P6 protein of haemophilus influenzae.
 13. The method of claim 11 where the vaccine contains an epitope of P5 protein of haemophilus influenzae.
 14. The method of claim 11 where the vaccine is a vaccine against hepatitis B. 